Preventing HIV in African adolescents

Young people are at the centre of the HIV/AIDS epidemic, with 15 to 24-year-olds accounting for half of new cases in developing countries.

There is an increasing recognition that adolescents and young people are falling through the gaps in HIV services, which should be tailored to their needs.

In the 1990s, researchers at the School documented a steep rise in the prevalence of HIV between 15 and 19 year olds in sub-Saharan Africa, demonstrating a need for sexual and reproductive health interventions targeted at this age group.

Richard Hayes, professor of epidemiology and public health at the School and David Ross, professor of epidemiology and international health, conducted two major programmes in partnership with researchers from University College London, Tanzania and Zimbabwe.

These included two randomised controlled trials, which showed that it was possible to implement high quality interventions in schools led by teachers (MEMA kwa Vijana Trial in Tanzania) or young adult volunteers (Regai Dzive Shiri Trial in Zimbabwe). Young people’s knowledge of sexual health increased and the interventions had an impact on self-reported risky sexual behaviour. However, there was no similar impact on HIV or pregnancy rates.

Schools in Tanzania, Zimbabwe and Zambia have introduced lessons based on the Tanzanian study and the materials are freely available online in both English and Swahili. The results were also important evidence for the World Health Organization (WHO) in the development of its 2011 guidelines on preventing pregnancy among adolescents in developing countries.

A series of qualitative studies linked to the trial in Tanzania showed the link between social norms and risky sexual behaviour. For example, it is socially acceptable for young women to exchange sex for gifts or support.

In collaboration with the World Health Organization, Ross and colleagues led the Steady… Ready… Go reviews, which examined which HIV-preventive strategies work in adolescents and concluded that curriculum-based programmes in schools and other community-based interventions were successful in improving self-reported sexual risk behaviours.

The United Nations Educational, Scientific and Cultural Organization drew heavily on the Tanzanian and Zimbabwean trials as well as the ‘Steady… Ready… Go’ reviews in its 2009 guidance on sexuality education. International agencies and governments have also used ‘Steady… Ready… Go’ to help focus their education priorities.

In July 2013, Ross and colleagues presented the latest review of global evidence on the effectiveness of interventions for HIV prevention, treatment and care among adolescents to the United Nations Children’s Fund (Unicef). The fund’s new operational guidance draws heavily on this work.